Long waits and back ups in hospital emergency departments (EDs) put patients at risk. Our overall aim is to reduce patient risk using a patient flow process called "Door-to-Doc" (D2D). This process improves patient care by reducing the time patients wait to see an ED physician and by speeding the process of moving ED patients who need to be admitted to the most appropriate inpatient (IP) nursing unit. Our specific hypothesis is that we can generalize D2D to improve patient care at all Banner Health EDs. The diversity of patient population and business in the eight Banner hospitals involved in this program provides a "living laboratory" for implementing and evaluating D2D as a safe practice. We have four specific aims in this project: 1. While implementing and refining D2D for the different Banner hospitals, we will develop guidelines so EDs can adapt D2D for their specific facility populations and business. 2. As a patient safety improvement effort, we will collect and evaluate the impact of D2D as a safe practice at each Banner ED. 3. No ED functions in isolation. Backups in admitting ED patients to appropriate nursing units originate in the nursing units, not the ED itself. We will use simple quantitative methods (that do computing) to determine the size and business parameters at which D2D is most effective and will make these tools available as generic elements of our toolkit. 4. D2D requires changes in the way physicians, nurses, management and staff work. We will develop training tools, techniques, monitoring and assessment aids to help hospital staff make the transition to D2D. [unreadable] [unreadable]